- Healthfirst (MA)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **This position is 100% Remote **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification… more
- Highmark Health (Boston, MA)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over… more
- Tufts Medicine (Burlington, MA)
- …and oversight to Utilization Review departments and UM vendor management. The UM Operations Manager is responsible for compliance with CMS Conditions of ... (ACM, CCM, CMAC) 3. Five (5) years of progressive UM / Case Management leadership in an acute-care hospital...2. **Vendor & Stakeholder Management** : Serves as day-to-day manager between outsourced UM vendor teams and… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for determining appropriate ... regulatory and reimbursement requirements of various commercial and government payers. Manages UM department in the context of other Revenue Cycle functions such as… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the daily ... decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of Utilization… more
- Highmark Health (Boston, MA)
- …resource utilization, identification of opportunities for referral to a Health Coach/ case management, and identification and resolution of quality issues. Monitors ... with established industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable state, federal… more
- US Tech Solutions (Canton, MA)
- …frames. The Clinical Reviewer functions as a member of the Precert / Outpatient UM team and works under the general direction of the Precertification Team Manager ... identifies trends in Utilization Management applicable to the precertification and outpatient UM processes. + Assists in the screening of appeal cases to provide… more
- Tufts Medicine (Burlington, MA)
- …multiple revenue cycle and hospital departments, such as Coding, Utilization Management ( UM ), Case Management, Quality and Physician advisors and leaders. The ... and evaluate the CDI program. This includes management of case mix index (CMI), length of stay (LOS), Observed...Director oversees the manager and clinical documentation specialists (CDSs) in planning, implementing… more
- Sharecare (Boston, MA)
- …hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision ... members to Clinical Advocates (Nurse) for conditions that require clinical care and case management assistance + Primary duties include but are not limited to: +… more